{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:06:36Z","timestamp":1790366796368,"version":"4.1.0"},"reference-count":47,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,2,26]],"date-time":"2020-02-26T00:00:00Z","timestamp":1582675200000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,2,7]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Queensland, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Men and women with a mean age 50 years modelled for 30 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Daily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>Costs, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Per 100\u2009000 individuals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47\u2009682 and 64\u2009659 keratinocyte cancers and \u00a3493.5, \u00a3386.4 and \u00a3406.1\u2009million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-034388","type":"journal-article","created":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T04:15:35Z","timestamp":1582776935000},"page":"e034388","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3159-4249","authenticated-orcid":false,"given":"Louisa","family":"Gordon","sequence":"first","affiliation":[{"name":"Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia"},{"name":"School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia"},{"name":"School of Public Health, University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4483-1888","authenticated-orcid":false,"given":"Catherine","family":"Olsen","sequence":"additional","affiliation":[{"name":"Cancer Control Group, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C","family":"Whiteman","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Queensland, Brisbane, Queensland, Australia"},{"name":"Cancer Control Group, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Janda","sequence":"additional","affiliation":[{"name":"Centre of Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia"},{"name":"School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adele","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia"},{"name":"CRUK Manchester Institute and Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,26]]},"reference":[{"key":"2025121221254351000_10.2.e034388.1","unstructured":"IARC Globocan WHO . Cancer today interactive web tool, 2018. Available: http:\/\/gco.iarc.fr\/today\/home [Accessed 31 Aug 2018]."},{"key":"2025121221254351000_10.2.e034388.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.08.036"},{"key":"2025121221254351000_10.2.e034388.3","first-page":"729","article-title":"Common benign skin tumors","volume":"67","author":"Luba","year":"2003","journal-title":"Am Fam Physician"},{"key":"2025121221254351000_10.2.e034388.4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.28.7078"},{"key":"2025121221254351000_10.2.e034388.5","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-06-0352"},{"key":"2025121221254351000_10.2.e034388.6","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.24747"},{"key":"2025121221254351000_10.2.e034388.7","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1016\/j.jid.2018.04.017","article-title":"Physician skin checks before the diagnosis of melanoma correlate with tumor characteristics","volume":"138","author":"Olsen","year":"2018","journal-title":"J Invest Dermatol"},{"key":"2025121221254351000_10.2.e034388.8","first-page":"472","article-title":"Melanoma staging: evidence-based changes in the American joint Committee on cancer eighth edition cancer staging manual","volume":"67","author":"Gershenwald","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"2025121221254351000_10.2.e034388.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e3502","article-title":"Preventing overdiagnosis: how to stop harming the healthy","volume":"344","author":"Moynihan","year":"2012","journal-title":"BMJ"},{"key":"2025121221254351000_10.2.e034388.10","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1001\/archdermatol.2012.893","article-title":"Frequency of excisions and yields of malignant skin tumors in a population-based screening intervention of 360,288 whole-body examinations","volume":"148","author":"Waldmann","year":"2012","journal-title":"Arch Dermatol"},{"key":"2025121221254351000_10.2.e034388.11","doi-asserted-by":"publisher","DOI":"10.1023\/B:CACO.0000036451.39128.f6"},{"key":"2025121221254351000_10.2.e034388.12","doi-asserted-by":"crossref","first-page":"194","DOI":"10.7326\/0003-4819-150-3-200902030-00009","article-title":"Screening for skin cancer: an update of the evidence for the U.S. preventive services Task force","volume":"150","author":"Wolff","year":"2009","journal-title":"Ann Intern Med"},{"key":"2025121221254351000_10.2.e034388.13","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1001\/jamadermatol.2015.0739","article-title":"Sun protection and skin examination practices in a setting of high ambient solar radiation: a population-based cohort study","volume":"151","author":"Olsen","year":"2015","journal-title":"JAMA Dermatol"},{"key":"2025121221254351000_10.2.e034388.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1087-0024.2003.09114.x"},{"key":"2025121221254351000_10.2.e034388.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2005.10.007"},{"key":"2025121221254351000_10.2.e034388.16","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1001\/jamadermatol.2013.9313","article-title":"Clinical skin examination outcomes after a video-based behavioral intervention: analysis from a randomized clinical trial","volume":"150","author":"Janda","year":"2014","journal-title":"JAMA Dermatol"},{"key":"2025121221254351000_10.2.e034388.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0167521","article-title":"The productivity costs of premature mortality due to cancer in Australia: evidence from a Microsimulation model","volume":"11","author":"Carter","year":"2016","journal-title":"PLoS One"},{"key":"2025121221254351000_10.2.e034388.18","unstructured":"Queensland Cancer Statistics On-Line . Viertel cancer research centre, based on data released by the Queensland cancer registry (1982-2014 released January 2017) Brisbane, Australia: cancer Council Queensland, 2017. Available: qcsol.cancerqld.org.au [Accessed 12 Aug 2018]."},{"key":"2025121221254351000_10.2.e034388.19","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.1056\/NEJMoa1709684","article-title":"Nivolumab and ipilimumab in advanced melanoma","volume":"377","author":"Wolchok","year":"2017","journal-title":"N Engl J Med"},{"key":"2025121221254351000_10.2.e034388.20","unstructured":"Australian Bureau of Statistics . Life tables 2015-2017. Canberra: Commonwealth of Australia, 2018."},{"key":"2025121221254351000_10.2.e034388.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2005.08.072"},{"key":"2025121221254351000_10.2.e034388.22","doi-asserted-by":"crossref","first-page":"339","DOI":"10.5694\/mja17.00284","article-title":"The incidence and multiplicity rates of keratinocyte cancers in Australia","volume":"207","author":"Pandeya","year":"2017","journal-title":"Med J Aust"},{"key":"2025121221254351000_10.2.e034388.23","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1002\/ijc.31141","article-title":"Generational shift in melanoma incidence and mortality in Queensland, Australia, 1995-2014","volume":"142","author":"Aitken","year":"2018","journal-title":"Int J Cancer"},{"key":"2025121221254351000_10.2.e034388.24","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.139.4.451"},{"key":"2025121221254351000_10.2.e034388.25","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/1753-6405.12738","article-title":"Multiplicity of skin cancers in Queensland and their cost burden to government and patients","volume":"42","author":"Gordon","year":"2018","journal-title":"Aust N Z J Public Health"},{"key":"2025121221254351000_10.2.e034388.26","doi-asserted-by":"crossref","first-page":"2270","DOI":"10.1016\/j.jid.2016.03.014","article-title":"Ten-Year survival after multiple invasive melanomas is worse than after a single melanoma: a population-based study","volume":"136","author":"Youlden","year":"2016","journal-title":"J Invest Dermatol"},{"key":"2025121221254351000_10.2.e034388.27","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.jaad.2017.05.050","article-title":"Cancer risks and survival in patients with multiple primary melanomas: association with family history of melanoma and germline CDKN2A mutation status","volume":"77","author":"Helgadottir","year":"2017","journal-title":"J Am Acad Dermatol"},{"key":"2025121221254351000_10.2.e034388.28","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1111\/bjd.16098","article-title":"A systematic review and meta-analysis of utility estimates in melanoma","volume":"178","author":"Tran","year":"2018","journal-title":"Br J Dermatol"},{"key":"2025121221254351000_10.2.e034388.29","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1111\/ajd.12205","article-title":"Quality of life in non-melanoma skin cancer","volume":"56","author":"Gaulin","year":"2015","journal-title":"Australas J Dermatol"},{"key":"2025121221254351000_10.2.e034388.30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2009.01291.x"},{"key":"2025121221254351000_10.2.e034388.31","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/j.1365-4632.2004.02477.x","article-title":"How are solar keratoses treated by general practitioners in Australia?","volume":"45","author":"Streeton","year":"2006","journal-title":"Int J Dermatol"},{"key":"2025121221254351000_10.2.e034388.32","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X08315247"},{"key":"2025121221254351000_10.2.e034388.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2012.04.014"},{"key":"2025121221254351000_10.2.e034388.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2012.04.012"},{"key":"2025121221254351000_10.2.e034388.35","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0000000000000056"},{"key":"2025121221254351000_10.2.e034388.36","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1001\/jamadermatol.2016.4518","article-title":"Cost-effectiveness and budget effect analysis of a population-based skin cancer screening","volume":"153","author":"Pil","year":"2017","journal-title":"JAMA Dermatol"},{"key":"2025121221254351000_10.2.e034388.37","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.jval.2017.11.009","article-title":"A modeling study of the cost-effectiveness of a risk-stratified surveillance program for melanoma in the United Kingdom","volume":"21","author":"Wilson","year":"2018","journal-title":"Value Health"},{"key":"2025121221254351000_10.2.e034388.38","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.jval.2016.12.017","article-title":"Cost-Effectiveness analysis of a skin awareness intervention for early detection of skin cancer targeting men older than 50 years","volume":"20","author":"Gordon","year":"2017","journal-title":"Value Health"},{"key":"2025121221254351000_10.2.e034388.39","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1200\/JCO.2016.68.4308","article-title":"Cost-Effectiveness of skin surveillance through a specialized clinic for patients at high risk of melanoma","volume":"35","author":"Watts","year":"2017","journal-title":"J Clin Oncol"},{"key":"2025121221254351000_10.2.e034388.40","doi-asserted-by":"crossref","first-page":"447","DOI":"10.5694\/j.1326-5377.1988.tb139568.x","article-title":"Diagnosis of skin cancer in the general population: clinical accuracy in the Nambour survey","volume":"148","author":"Green","year":"1988","journal-title":"Med J Aust"},{"key":"2025121221254351000_10.2.e034388.41","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2009.141"},{"key":"2025121221254351000_10.2.e034388.42","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdt032"},{"key":"2025121221254351000_10.2.e034388.43","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1001\/jamadermatol.2018.3086","article-title":"Use and cost of actinic keratosis destruction in the Medicare Part B fee-for-service population, 2007 to 2015","volume":"154","author":"Yeung","year":"2018","journal-title":"JAMA Dermatol"},{"key":"2025121221254351000_10.2.e034388.44","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1177\/0969141317734003","article-title":"Observed and expected mortality in the German skin cancer screening pilot project screen","volume":"25","author":"Eisemann","year":"2018","journal-title":"J Med Screen"},{"key":"2025121221254351000_10.2.e034388.45","doi-asserted-by":"crossref","first-page":"3956","DOI":"10.1200\/JCO.2016.69.5874","article-title":"Sunscreen use in the prevention of melanoma: common sense rules","volume":"34","author":"Nijsten","year":"2016","journal-title":"J Clin Oncol"},{"key":"2025121221254351000_10.2.e034388.46","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s40258-017-0341-y","article-title":"Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis","volume":"15","author":"Elliott","year":"2017","journal-title":"Appl Health Econ Health Policy"},{"key":"2025121221254351000_10.2.e034388.47","doi-asserted-by":"crossref","unstructured":"Reeve R , Srasuebkul P , Langton JM , et al . Health care use and costs at the end of life: a comparison of elderly Australian decedents with and without a cancer history. BMC Palliat Care 2018;17.doi:10.1186\/s12904-017-0213-0","DOI":"10.1186\/s12904-017-0213-0"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-034388","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:25:55Z","timestamp":1765603555000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-034388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2,26]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/bmjopen-2019-034388"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-034388","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}